The burden of suffering from colorectal cancer is substantial. Although there has been tremendous progress in understanding the biology of colorectal cancer, and important advances in treatment, there is a lack of knowledge about the effect of specific process measures on health and behavioral outcomes. The long-term objective of the proposed study is to establish a system to examine the relationship of processes of care to clinical and patient care outcomes. The specific aims of this research are: 1) To assess determinants of access to cancer care services according to patient, health care delivery system and physician characteristics. 2) To describe variations in cancer practice patterns in vulnerable populations. 3) To longitudinally assess a range of clinical and patient-oriented health outcomes. 4) To identify patient, provider, and health system factors influencing the dissemination of effective interventions. 5) To assess the contribution of lifestyle factors on prognosis and outcomes. 6) To examine comorbid illness, diagnostic workup, surgical management and details of staging to investigate racial disparity. The study will enroll a population-based cohort of 1000 newly diagnosed colorectal cancer patients from a 22-county area in central and eastern North Carolina. To evaluate racial disparities, the study will include equal numbers of blacks and whites. Cases will be identified using the rapid ascertainment mechanisms of the North Carolina Central Cancer Registry using methods from an ongoing population-based case-control study. Cases will be interviewed by telephone and mailed surveys. Staff from Medical Review of North Carolina, a non-profit quality improvement organization, will abstract hospital records and physician office charts. Special research projects will 1) evaluate the effect of functional health literacy on treatment and outcomes; 2) collect blood specimens and tumor blocks to create a biorepository for future analyses.